Understanding Seizures and Epilepsy

The term ‘chronic disorder’ may bring to mind conditions like diabetes or hypertension. But did you know that it also includes epilepsy?

Epilepsy, which means "seizure disorder,” is the fourth most common neurological condition and affects people of all ages. Nationwide, it affects 3.4 million  people: approximately 3 million adults,  and  470,000 children.

What does epilepsy look like?

Although a traumatic brain or head injury, tumor, stroke, or central nervous system infection may trigger epilepsy, its cause is generally unknown. “In some cases, it is inherited,” according to Padmaja Kandula, M.D., Director of The Epilepsy Center at Weill Cornell Medicine and NewYork-Presbyterian. In most cases, it presents during infancy through young adulthood (older teens). “There are childhood syndromes such as childhood absence epilepsy that patients can outgrow by puberty,” Dr. Kandula says.

Epilepsy varies by type and seizure. A person with it can have more than one type of seizure. In some people, for example, a seizure can appear as momentary confusion or a stare at something that isn’t there; while, in others it can cause physical collapse, shaking, and unfamiliarity with previously familiar surroundings.

If you or a loved one has two unprovoked seizures (or one unprovoked seizure with the likelihood of more) that are unrelated to known and reversible medical conditions like alcohol withdrawal, or extremely low blood sugar, then you may receive an epilepsy diagnosis.

Epilepsy need not mean incapacitation

Yet, having a seizure does not necessarily mean you have epilepsy. Seizures, which can last from a few seconds to a few minutes, may result from other medical problems, including high fever, low blood sugar, or substance or alcohol withdrawal.

Moreover, having epilepsy does not mean you will live a limited or incapacitated life, Dr. Kandula says. “There is an ongoing misconception that individuals with epilepsy are permanently incapacitated and cannot ever drive or live full lives, including having a family and career,” she says. “Employers are under the misconception that patients with epilepsy all have high absenteeism or are problem employees, or that epilepsy cannot be controlled like any other chronic disease. But no statistics support any of this.”

For most individuals with epilepsy, living a full and productive life--including having a safe pregnancy--is feasible. “However, this is contingent on how well controlled the epilepsy might be,” Dr. Kandula says.  “There is a small number of individuals at risk for sudden unexpected death in epilepsy or SUDEP, whose risk factors include uncontrolled seizures, severe seizures (convulsions), and medication non-compliance.”

Patients with uncontrolled epilepsy do face certain limitations. For example, driving or swimming are too dangerous, as are flying aircraft or commercial vehicles. They cannot even obtain any type of pilot's license. “Special exemptions on a case-by-case basis can be made for those patients who have been seizure-free without medication for 10 or more years,” Dr. Kandula explains.

Lowering your risk for epilepsy

Some of the most common ways to reduce your chances of developing epilepsy include:

• Preventing traumatic brain injuries by using safety belts,  child passenger seats, airbags, bicycle and motorcycle helmets to reduce motor vehicle and traffic injuries.
• Lowering your chances of stroke and heart disease by eating well, exercising safely, and not smoking.
• Getting vaccinated to lower your chances of acquiring infections that can lead to epilepsy. Review the CDC  Recommendations for Vaccines and Immunizations.
• Washing your hands and preparing food safely to avoid cysticercosis, a parasite-borne infection and the most common cause of epilepsy world-wide. Health screening and early treatment for cysticercosis can prevent epilepsy.
• Staying healthy during pregnancy by following a prenatal care plan with your doctor or nurse, to keep you and your baby healthy.

Although epilepsy cannot be cured, medication, diet, or surgery may control seizures in some people. “Anticonvulsant medications remain the mainstay for epilepsy patients,” Dr. Kandula says. “Nearly 70% of patients are well controlled on medication alone. For the remaining one-third of medication-resistant patients, there are non-pharmacologic treatments available such as neuro-stimulatory devices, both peripheral and central,” she says. These include peripheral vagus nerve stimulators (similar to a cardiac pacemaker placed in the chest) and central (or intracranial) neurostimulators, such as the Deep Brain  Stimulator or responsive nerve stimulator (which can also deliver treatment and record intracranial brain rhythms to detect seizures). But in most cases, she says, epilepsy can be controlled like any other chronic disease.